| NPI | 1477282952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: OK 7976) |
| Additional Taxonomies | 122300000X Dentist (Licence: IL 019034187) |
| 1223G0001X Dentist, General Practice (Licence: MN Student) | |
| 122300000X Dentist (Licence: MO 2024017633) | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2025-09-23 |